The Power of Rest

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Hospital Costs and You—Making the Surreal Real

Can prices really vary 120 times for the same service? They sure can.

“This Is Ridiculous”

 

When it comes to American health care, the impossible often transforms into the routine. Add another feature to the list —hospital costs.

As I write in my new book “Healthy Without Health Insurance,” people look at their medical/hospital bills and notice “an extra zero. Make that two zeroes.”

Consider appendectomies.

As reported by Roni Rabin in the 4/24/12 New York Times, Renee Hsia, an ER doc at UCSF, investigated prices for appendectomies in northern California. All were uncomplicated. The patients were home within four days. sides.

So here we have a standard procedure, people out quickly, something you can fit it under any number of medical protocols. Clearly prices for this typical, common surgical procedure should not vary that much. Right?

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Yet the cost differential was between $1,500 and $182,000—for the same procedure. Or as Dr. Hsia put it, “We expected to see variations of two or three times the amount, but this is ridiculous,. There’s no rhyme or reason for how patients are charged or how hospitals come up with charges.

“There’s no other industry where you get charged 100 times the same amount, or 121 times, for the same product,” she said.

Guess, my friends, who gets caught with the tab?

 

You’re Not Alone

The appendectomy data are not outliers. The University of Pittsburgh looked at other procedures. Variations in price for a hysterectomy in California hospitals in 2007? Between $3500 and $65,300.

But that was only for the data they were able to get. Two thirds of hospitals refused to say how much they charge. Consumers of course have even less recourse than academic researchers.

When quoting prices, hospitals generally leave out numerous “ancillary” bills. Not only are some of these costs high, but many will not be paid for by insurance—assuming you have any.

And the health insurers have changed the rules again.

 

The Strange Case of New York State

People have long felt that health providers have created ingenious ways to charge them. Years ago Andrew Cuomo, present governor of New York,  argued that insurers should stop using Ingenix, a data base put out by United Health. Many hospitals and doctors felt Ingenix consistently undercharged by coming up by “usual and customary fees” that were way out of date.

So the insurers put their data into the new program—deemed “Fair Health”. It was so fair they proceeded to ignore it.

Their new tactic—using Medicare fees. In many localities, Medicare fees were far below “usual and customary”—which is why many providers refused to take them.

So now there’s a bigger gap between fees charged and insurance payments. And guess who gets caught paying the extra tab? If you said you, the consumer, you would be correct.

And you will have new, unexpected opportunities to pay these increased bills. Outside debt collectors are now placed in some hospital ERs to make sure you pay up for your treatment—in advance.

 

What You Can Do

First, you must protect yourself. “Healthy Without Health Insurance” provides a simple, inexpensive program to get you healthy. It uses your body’s ultimate trade secret—it’s ability to regenerate itself.

Human biology is incredibly fast. The pumping proteins in your heart that provide you the blood that lets you read this sentence are made, used, repaired, crunched into bits and recycled inside 60-90 minutes. Most of your heart is new in about three days.

What you do is what you become. Live in a way that fits what your body is built to do and it can rebuild itself more effectively—sometimes with astonishingly positive results.

Through efforts we control we can make our rapid regeneration more productive. We can improve our mental, physical, social and spiritual well-being. But bad luck and sickness eventually occur.

So when you do get ill, what can you do to control your medical costs?

 

Negotiate

Hospitals often will not tell you how much something will cost because they often don’t know the price. Really.

They get paid different amounts by every insurer—sometimes by the same insurer—on different days of the week. They check their formulas and come up with their supposed costs. But minor changes in language and calculations can massively change the bill.

So, first, if you don’t have insurance, negotiate everything with a hospital or doctor up front. Find out what your costs will be—in writing.

And if you possess insurance, do the same. As much as possible, find out what your costs will be. Then negotiate—if they let you. Providers much prefer to be paid than to get nothing—though hospitals stuffed with tens of billions of dollars in unpaid bills have become very welcoming to collection agencies.

Is this any way to run a health care system? With prices that can vary 121 times for the same service?

You know it isn’t. Until health—national and personal well-being—becomes the priority of our crazy health care “system,” you better try and get as healthy as you can get.

Sorry. You don’t have much choice.

 

 

 

Matthew Edlund, M.D. researches rest, sleep, performance, and public health; he is the author of Healthy Without Health Insurance and The Power of Rest.

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